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        <BusinessNameLine1>Calumet Area Community Health Foundation Inc</BusinessNameLine1>
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        <ZIPCode>53014</ZIPCode>
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        <BookValue>236208</BookValue>
      </Land>
      <Equipment>
        <OtherCostOrOtherBasis>10484</OtherCostOrOtherBasis>
        <Depreciation>10470</Depreciation>
        <BookValue>14</BookValue>
      </Equipment>
      <OtherLandBuildings>
        <OtherCostOrOtherBasis>2636</OtherCostOrOtherBasis>
        <Depreciation>1876</Depreciation>
        <BookValue>760</BookValue>
      </OtherLandBuildings>
      <TotalOfBookValueLandBuildings>236982</TotalOfBookValueLandBuildings>
      <OtherLiabilities>
        <Description>Accrued Wages Payroll Taxes</Description>
        <Amount>1969</Amount>
      </OtherLiabilities>
      <TotalOfAmounts>1969</TotalOfAmounts>
      <TotalRevenue>224549</TotalRevenue>
      <TotalExpenses>93724</TotalExpenses>
      <ExcessOrDeficitForYear>130825</ExcessOrDeficitForYear>
      <NetUnrealizedGLOnInvestments>736148</NetUnrealizedGLOnInvestments>
      <TotalAdjustments>736148</TotalAdjustments>
      <ExcessOrDeficitPerFS>866973</ExcessOrDeficitPerFS>
      <TotRevenueEtcAuditedFinclStmt>933752</TotRevenueEtcAuditedFinclStmt>
      <NetUnrealizedGainsInvestments>736148</NetUnrealizedGainsInvestments>
      <RevenueNotRptdF990>736148</RevenueNotRptdF990>
      <RevenueSubtotal>197604</RevenueSubtotal>
      <InvestmentExpensesNotIncluded>26945</InvestmentExpensesNotIncluded>
      <RevenueNotRptdOnFinStmt>26945</RevenueNotRptdOnFinStmt>
      <TotalRevenuePerForm990>224549</TotalRevenuePerForm990>
      <TotExpensesEtcAuditedFinclStmt>66779</TotExpensesEtcAuditedFinclStmt>
      <ExpensesSubtotal>66779</ExpensesSubtotal>
      <InvestmentExpensesNotIncluded2>26945</InvestmentExpensesNotIncluded2>
      <ExpensesNotRptdOnFinStmt>26945</ExpensesNotRptdOnFinStmt>
      <TotalExpensesPerForm990>93724</TotalExpensesPerForm990>
    </IRS990ScheduleD>
    <IRS990ScheduleI documentId="990I" softwareId="11000218" softwareVersion="2011.0.0">
      <RecordsMaintained>true</RecordsMaintained>
      <RecipientTable>
        <RecipientNameBusiness>
          <BusinessNameLine1>Calumet Medical Center</BusinessNameLine1>
        </RecipientNameBusiness>
        <AddressUS>
          <AddressLine1>614 Memorial Drive</AddressLine1>
          <City>Chilton</City>
          <State>WI</State>
          <ZIPCode>53014</ZIPCode>
        </AddressUS>
        <EINOfRecipient>390905385</EINOfRecipient>
        <IRCSection>170b1Aiii</IRCSection>
        <AmountOfCashGrant>15500</AmountOfCashGrant>
        <PurposeOfGrant>See Annual Report</PurposeOfGrant>
      </RecipientTable>
      <TotalNbrOfOtherOrganizations>1</TotalNbrOfOtherOrganizations>
      <Form990ScheduleIPartIII>
        <TypeOfGrant>Scholarships</TypeOfGrant>
        <NumberOfRecipients>16</NumberOfRecipients>
        <AmountOfCashGrant>16000</AmountOfCashGrant>
      </Form990ScheduleIPartIII>
    </IRS990ScheduleI>
    <IRS990ScheduleO documentId="990O" softwareId="11000218" softwareVersion="2011.0.0">
      <GeneralExplanation>
        <Identifier>Form 990 Part VI</Identifier>
        <ReturnReference>11b</ReturnReference>
        <Explanation>The process the organization uses is to include the Form 990 review in its Board of Directors meeting agenda and Board Members are able to to review the Form 990 at this meeting.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990 Part VI</Identifier>
        <ReturnReference>15a</ReturnReference>
        <Explanation>The organization determines the CEOs compensation based on comparability data furnished by the Association of Small Foundations.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990 Part VI</Identifier>
        <ReturnReference>19</ReturnReference>
        <Explanation>The organization makes its documents and financial statements available to the public upon request.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990 Part XI</Identifier>
        <ReturnReference>5</ReturnReference>
        <Explanation>Net Unrealized Gain on Investments</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990 Part VIII</Identifier>
        <ReturnReference>7</ReturnReference>
        <Explanation>The acquired and sold dates used for sale of securities are default dates due to the numerous number of security sales.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Explanation>Form 990 Part VI Section B Line 11b The process the organization uses is to include the Form 990 review in its Board of Directors meeting agenda and Board Members are able to to review the Form 990 at this meeting. Form 990 Part VI Section B Line 15a The organization determines the CEOs compensation based on comparability data furnished by the Association of Small Foundations. Form 990 Part VI Section C Line 19 The organization makes its documents and financial statements available to the public upon request. Form 990 Part XI Line 5 Net Unrealized Gain on Investments Form 990 Part VIII Line 7 The acquired and sold dates used for sale of securities are default dates due to the numerous number of security sales.</Explanation>
      </GeneralExplanation>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="990R" softwareId="11000218" softwareVersion="2011.0.0">
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>CALUMET MEDICAL CENTER</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>614 MEMORIAL DRIVE</AddressLine1>
          <City>CHILTON</City>
          <State>WI</State>
          <ZIPCode>53014</ZIPCode>
        </AddressUS>
        <EIN>390905385</EIN>
        <PrimaryActivities>HOSPITAL</PrimaryActivities>
        <LegalDomicileState>WI</LegalDomicileState>
        <ExemptCodeSection>170b1Aiii</ExemptCodeSection>
        <PublicCharityStatus>7</PublicCharityStatus>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
        <ControlledOrg>false</ControlledOrg>
      </Form990ScheduleRPartII>
      <ReceiptOfIntAnnRentsRoyalties>false</ReceiptOfIntAnnRentsRoyalties>
      <GiftGrantOrCapContrToOtherOrg>true</GiftGrantOrCapContrToOtherOrg>
      <GiftGrantOrCapContrFrOtherOrg>false</GiftGrantOrCapContrFrOtherOrg>
      <LoansOrGuaranteesToOtherOrg>false</LoansOrGuaranteesToOtherOrg>
      <LoansOrGuaranteesFromOtherOrg>false</LoansOrGuaranteesFromOtherOrg>
      <SaleOfAssetsToOtherOrg>false</SaleOfAssetsToOtherOrg>
      <PurchaseOfAssetsFromOtherOrg>false</PurchaseOfAssetsFromOtherOrg>
      <ExchangeOfAssets>false</ExchangeOfAssets>
      <RentalOfFacilitiesToOtherOrgs>false</RentalOfFacilitiesToOtherOrgs>
      <RentalOfFacilitiesFrOtherOrgs>false</RentalOfFacilitiesFrOtherOrgs>
      <PerformOfServicesForOtherOrgs>false</PerformOfServicesForOtherOrgs>
      <PerformOfServicesByOtherOrgs>false</PerformOfServicesByOtherOrgs>
      <SharingOfFacilities>true</SharingOfFacilities>
      <SharingOfPaidEmployees>false</SharingOfPaidEmployees>
      <ReimbursementPaidToOtherOrg>false</ReimbursementPaidToOtherOrg>
      <ReimbursementPaidByOtherOrg>false</ReimbursementPaidByOtherOrg>
      <OtherTransferToOtherOrg>false</OtherTransferToOtherOrg>
      <OtherTransferFromOtherOrg>false</OtherTransferFromOtherOrg>
    </IRS990ScheduleR>
  </ReturnData>
</Return>